Get Started: Buying a New Home Step 1 of 7 0% Personal InfoNameDate of birth MM slash DD slash YYYY Do you have a spouse or significant other? Yes No Email(s)Add all within household Add RemoveBest phone number(s) to reach you?Add all within household Add RemoveText ConsentA quick and easy way to communicate with our customers is via text- we may text you regarding your active quotes or regarding notices on your current policies. Please consent to engage in text conversations with our team by selecting “yes” below. Message frequency varies. Message and data rates may apply. If you select “no” we will communicate via voice and email only. You can opt-out anytime by replying “STOP” to any of our text messages. Yes No Real Estate Info Who referred you to Jefferson Avenue?We love to thank the people who refer our shop.When is the closing date ?(or hopefully the earliest closing date) MM slash DD slash YYYY Property Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Driver's LicenseUpload or Snap Photo(s)Include all licenses from people in the household Drop files here or Select files Accepted file types: jpg, jpeg, png, pdf, doc, docx, odt, Max. file size: 300 MB. Manually Enter License InfoLicense #Exp. DateFull NameState(Initials) Add Remove Current Property Address Please provide us with the most current address you have lived at for at least 1 year. Address Street Address Address Line 2 City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Upload Documents Please provide us with all of your most recent insurance declarations pages and insurance quotes you may have gotten thus far, these will be super helpful in helping you compare options. Any interest in bundling? A lot of insurance carriers give huge discounts if they are able to earn the auto and home insurance as a package. Feel free to send us any policies you may have. The EASIEST WAY to send us your CURRENT INFORMATION is to use Canopy Connect! This shouldn't take you more than 30 seconds to complete! All you need to do is CLICK HERE and sign in to your current insurance company's portal. It will securely send over all information we need to give you the best quote. If you prefer to upload documents manually, attach your current insurance documents here. You can find this under the “My policy” or “My documents” tab on your carriers’ website.Insurance DocumentsUpload or Snap Photo(s) Drop files here or Select files Max. file size: 300 MB. Additional DocumentsUpload or Snap Photo(s) Drop files here or Select files Max. file size: 300 MB. Additional Property InfoThis property will be a... Primary Residence Investment/Rental Property Flip Is the property in good shape? Are the electrical, plumbing, heating, and the roof up to date and code? Yes No Do you have any dogs? Yes No Any businesses on or surrounding the home? Yes No How old is your roof? Additional Property Info (cont.)Are there any of the following in the home? Coal/Wood Burning Stoves Swimming Pools Trampolines Fire Breathing Dragons Other Crazy Things None of the Above Additional Info Hey, if you don’t do online forms, no hard feelings. Feel free to opt out and talk to a real person! (610) 260-3078 service@jeffersonaveinsurance.com